New AHA Statement Highlights Newer Approaches to Exercise as Medicine

For the first time in more than 10 years, the American Heart Association (AHA) has revised its official position on “Exercise Testing and Training”, relying on a team of international experts, including University of Vermont Professor of Medicine Philip Ades, M.D. Titled “Exercise Standards for Testing and Training,” the new statement appears in a July 22, 2013 epub in Circulation: Journal of the American Heart Association.

Ades, a cardiologist and director of cardiac rehabilitation and preventive medicine at Fletcher Allen Health Care, served as co-chair of the statement and chair of the exercise training writing group. His research, focused on exercise training among cardiac rehabilitation patients, has shown that rigorous activity that more effectively burns calories helps overweight and obese coronary patients lose weight and reduce cardiac episode recurrence.

In terms of what’s new in this AHA statement, Ades notes that the writing group took the approach that different types of exercise should be targeted for different outcomes. For example, if exercise is prescribed as an adjunct to diet for weight loss, it should burn calories so the mantra should be “walk daily and walk far.” If exercise is targeting physical function in an older woman, strength training is the focus since older women are often limited in their performance of physical activities by a lack of strength. If the goal is to increase fitness, higher intensity interval training should be considered. Additionally, the writing group made an effort to remove any barriers to exercise training such that if an individual is not symptomatic and is undertaking a walking program for general health maintenance and prevention, a screening exercise test is rarely needed.

The new statement also addresses exercise in clinical populations, such as individuals with coronary heart disease where a stress test preceding exercise is routinely performed to ascertain that exercise that exercise is safe and to guide exercise intensity for the individual. In most of these cases exercise is optimally started in a cardiac rehabilitation program.

“For heart patients, exercise should be viewed as a medication that one doses almost daily,” said Ades. “For that given day it lowers blood pressure, improves insulin sensitivity, improves mood and acts as a stress manager. It also lengthens life and improves the quality of life.”